It has been ten weeks. My internship at Aravind is over, and I am on the verge of leaving India for home. The time has flown by. The first day of this journey, when I met Olivia at JFK and caught an Air India flight to meet up with the other CASI interns in Delhi, does not feel like 10 weeks ago at all. The question that I am left with is what really came of those ten weeks? What have I done, what have I learned?
My projects are now essentially complete. If you will recall, I was working on two projects, one related to patient safety and one related to patient satisfaction. I helped to compile a patient safety manual with all protocols of all departments and some presentations to help with raising awareness about patient safety among staff. As a second project, my work with the patient satisfaction data has yielded some insights about the Aravind patient experience that have been compiled into a report, and in the final weeks we may have hit upon a way to better score patient satisfaction, that uses some of the methodologies of the Center for Medicare and Medicaid Services (CMS) in the US.
As I write out the results of my projects, I cannot help but feel that there was more to be done. With more time, I could have done more to push the installation of new patient safety initiatives; I could have included several additional forms of analysis in going through the patient satisfaction dataset. And it hurts, feeling that there may have been rocks left unturned and knowing that much more work is needed to address patient safety and satisfaction.
I think that those thoughts are mostly a product of the fact that these projects are part of work with an extremely long arc. Patients don’t just become safe or satisfied in two months. The work of protecting patient health and meeting patient needs is constant and perennial. The challenge in this context is in making iterative improvements and refining parts of the system each day so that care can improve over time. Yet, even understanding the nature of long term projects, I think that in the world of development and service, this sense (that your impact was not fully felt or made) is something that can be difficult to reconcile. We all want that striking before-and-after picture which can allow us to quantify our impact. We all want to know that we made a difference.
And this, I think brings me to what I have learned this summer. Of course I have gained a lot in terms of learning about some of the technical issues of running a hospital, i.e. how do you bring down costs in the developing (and, frankly, the “developed”) world, how do you generate revenue to sustain a hospital when many don’t have insurance, how do you measure quality effectively. But equally important as these technical insights has been learning about what it means to have an impact and make a difference more generally. What does it take to meaningfully improve the lives of the people around you? There are two ideas that I think I will remember forever relating to this issue, and they both come from the vision of the founder of Aravind, Dr. V.
The first idea has to do with McDonald’s (of all things). Dr. V saw McDonald’s as a key model in creating Aravind. The goal of Aravind was to be the McDonald’s of eye care. Aravind was supposed to be able to deliver eye care at prices that anyone could afford using a standardized process that ensured a certain level of quality. Extending this analogy further, the idea was that in the same way that McDonald’s is able to use franchising to sell big Macs in every corner of the earth, it should be possible to design a blueprint for a high quality, standardized process that can be franchised and used beyond Madurai. One of the underlying notions is that if you want to cure blindness all over the world, you need a structure where it should be possible to slot anyone, anywhere in the world, into the system and have that system function. Of course, Aravind uses doctors and nurses instead of fry cooks and cashier managers, but the concept is the same. The key to making a difference across the world at scale on the order of global health is not superstar individuals, but rather processes and structures that allow ordinary people to do something extraordinary. This is fundamental, and it harkens back to the incredibly simple, Kindergarten-level, adage that teamwork at its best is incredibly powerful. A well-functioning team is infinitely more capable than the sum of its parts working individually.
This sounds great and undeniable, but if you are an individual in such a system, what is your psychology? Do you personally matter? Or are you a fry cook, who can be replaced? (please know that this is not intended to be a pejorative slight at all to the McDonald’s fry cooks out there; I am a big fan of their potato-fried work!) My sense in working at Aravind is that when you are a part of an institution that is working towards something consequential (like eliminating needless blindness), you don’t worry as much about your place. You sacrifice the self-assuredness that you personally are an essential part of making a difference for the assurance that you are part of something that is making a Huge (with a capital H) impact. I am leaving Aravind realizing that the biggest challenges and the greatest positive impacts can be sustained when a system of people work towards something. You can’t be afraid to be the fry cook if you’re working at the McDonald’s of eye care.
The second big idea comes from my favorite quote from Dr. V. In his words, “Intelligence and capability are not enough. There must also be the joy of doing something beautiful. Being of service to God and humanity means going well beyond the sophistication of the best technology, to the humble demonstration of courtesy and compassion to each patient.” The quote can be found written in places all over the Aravind Eye Hospital, including on a small sign in our office for the summer. The quote is so simple, and yet it is the most powerful thing that I take away from the summer. When I walked around the hospital and observed doctors, nurses, and administrators, I really felt that behind every person, there was “the joy of doing something beautiful.” People at Aravind are not shy about goals. The hospitals at Aravind and the many departments within the hospitals receive constant feedback through parameters and measures of quality. Everyone is trying to beat some mark, and across Aravind, the very tangible goal is to reach 100% of the patients in Tamil Nadu. What I have realized, though, is that there is more to the work than achieving the goals. There is more to Aravind than the goal of eliminating needless blindness. Embedded within the culture is an appreciation and love of the pursuit of that goal. In a way, just the fight, just the challenge, just the struggle for something that you believe in, can be enough. Moreover, when you love that struggle, you really have an edge in overcoming all of the obstacles and achieving something. These past two months were fast, and I leave knowing that there is so much more to be done. But for a few months, I felt “the joy of doing something beautiful,” and I move on, understanding that I can find that joy again and in finding it, make a difference in the world.
With that, so long to India, and so long to a summer of adventure and discovery. It is time to find something “beautiful” back in the US.